Dear Doctors: I am a 69-year-old African American male with high blood pressure. I got conflicting advice from my primary care doctors, and my BP readings were never taken in the same conditions. I am confused and have lost faith in my medical network. Can I see a specialist for hypertension?
Dear Reader: As doctors, and also as patients, we feel your plight. Blood pressure, or BP, is an important measure of maintaining good health and well-being. However, accurate readings are often a challenge. The main reason for this is that blood pressure fluctuates, not only throughout the day, but also from moment to moment.
Factors that can influence a person’s blood pressure reading include general physical health, medications or supplements they are taking, caffeine and alcohol use, hydration, sleep, exercise, family history, their emotional situation and even what they had for breakfast that morning. Check someone’s blood pressure 10 times throughout the day, and you’ll get 10 odd different readings.
Adding to the difficulty is that blood pressure readings taken in a medical office can be artificially high. Usually there is even a name for it: “white coat hypertension.” Therefore, in our own practices, we do not worry about the numbers reached in the office and focus more on the readings taken when at home. We advise patients to check BP in the morning, while they are calm and at rest. These readings are usually an accurate representation of resting BP.
In tests used to reach blood pressure guidelines, participants are asked to sit quietly for a set period of time before BP readings are taken. The effects of blood pressure medications, which are usually dosed daily, last for 24 hours. The timing of these medications should not affect BP readings. The goal, according to current guidelines, is 130/80 for everyone.
Ambulatory blood pressure monitoring, which involves wearing a device that takes multiple readings over a 24-hour period, is possible. However, we do not use this method in our own practices. We find a week’s worth of readings taken first thing in the morning will give an accurate and instructive average.
If we see a significant difference between the readings in the morning and those taken later in the day, when the stresses of daily life have begun, that indicates questions about the tone of the nervous system. With our patients, we open a discussion about methods of “training” the nervous system to be less prone. This may include deep breathing, meditation or mindfulness exercises, or practices such as yoga and tai chi. Walking, weight lifting and being in nature have been proven to help manage blood pressure.
As for your question about working with a specialist, it is definitely an option. If blood pressure is difficult to control, a cardiologist can help. Kidney problems can also contribute to hypertension. For that reason, your primary care doctor may request some tests to see if a kidney specialist, known as a nephrologist, is a good choice.
(Send your questions to (email protected), or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Due to the number of mail, personal responses cannot be given.)
